Healthcare Provider Details

I. General information

NPI: 1285541136
Provider Name (Legal Business Name): DIRECT BEHAVIORAL HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MARSHANE RD
REISTERSTOWN MD
21136-5860
US

IV. Provider business mailing address

1000 MARSHANE RD
REISTERSTOWN MD
21136-5860
US

V. Phone/Fax

Practice location:
  • Phone: 301-785-3633
  • Fax: 631-517-1222
Mailing address:
  • Phone: 301-785-3633
  • Fax: 631-517-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIET NUMFOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-785-3633